AbstractEarly intervention following initial referral into healthcare services can have a significant impact on the prognosis and outcomes of patients. Long waiting times and nonattendance can have an immediate and enduring negative impact on patients and healthcare service providers. The traditional management options in reducing waiting times have largely revolved around setting performance targets, providing financial incentives or additional resourcing. This large-scale quality improvement project aimed to reduce waiting times from referral to first appointment and non-attendance for a wide range of services providing primary and secondary care mental health and community health services at East London NHS Foundation Trust (ELFT).

Fifteen community-based teams across ELFT came together with the shared goal of improving access. These teams were diverse in both nature and geography and included adult community mental health teams, child and adolescent mental health services, secondary care psychological therapy services, memory services, a musculoskeletal physiotherapy service and a sickle cell service. A collaborative learning system was developed to support the teams to come together at regular intervals, share data, test and scale-up ideas through quality improvement and have access to coaching from skilled improvement advisors in the ELFT central quality improvement team.

Over the course of the 2-year project, waiting time from referral to first face-to-face appointment reduced from an average of 60.6 days to 46.7 days (a 23% reduction), non-attendance at first faceto-face appointment reduced from an average of 31.7% to an average of 20.5% (a 36% reduction), while referral volume increased from an average of 1021 per month to an average of 1280 per month (a 25% increase).

Problem Frimley Park Hospital is a 750-bed National Health Service hospital in Surrey, near the Berkshire and Hampshire county borders. The Trauma and Orthopaedics (T&O) department consists of approximately 25 consultants, shared between six teams of specialty trainees, core trainees and foundation year one doctors.

As newly qualified doctors, we anticipated some jobs to be time consuming initially, which would improve as we adjusted to the role. However, as time went on, the weekend handover process became a repetitive issue.

WHERE THIS HAPPENED: Birmingham City Hospital, Queen Elizabeth Hospital Birmingham

BackgroundThe number of falls in hospital ranges from 3.8 to 8.6 falls per 1000 bed days.1 Around 30% of falls as inpatients are injurious, and 4%–6%can result in serious and life-threatening injury.2 3 This results in significant health burdens and economic burdens due to increased hospital stays following a fall. Junior doctors are usually the first point of contact for managing patients who fall in hospital. It is therefore important they understand the preventative measures and postfalls management. Aim To assess the retention of knowledge regarding falls management in foundation year 1 (FY1) doctors before and after a short educational intervention.

WHERE THIS HAPPENED: Harrogate and District NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Royal Free Hospital, London

Abstract In anaesthesia, the use of comparative performance reports, their impact on patient care and their acceptability is yet to be fully clarified. Since April 2010, postoperative data on theatre cases in our trust have been analysed and individual comparative performance reports distributed to anaesthetists. Our primary aim was to investigate whether this process was associated with improvement in overall patient care.

A short survey was used to assess our secondary aim, the usefulness and acceptability of the process. There were significant improvements in the odds of all outcomes other than vomiting: 39% improvement in hypothermia (p<0.001); 9.9% improvement in severe pain (p<0.001%); 9.6% improvement in moderate pain (p<0.001); 5.3% improvement in percentage pain free (p=0.04); 9.7% improvement in nausea (p=0.02); 30% improvement in unexpected admissions (p=0.001). 100% of consultant respondents agreed that performance reports prompted reflective practice and that this process had the potential to improve patient care.

The provision of comparative performance reports was thus associated with an improvement in outcomes while remaining acceptable to the anaesthetists involved.

WHERE THIS HAPPENED: Newcastle Upon Tyne Hospitals NHS Foundation Trust

Abstract High-quality perioperative diabetes care is essential to improve surgical outcomes for patients with diabetes. Inadequate perioperative diabetes care is associated with increased wound complications, higher mortality rates and increased length of hospital stay. Despite national guidelines, surgical wards remain a high-risk area for poor diabetes care. An initial baseline audit in 2014 of vascular patients with diabetes undergoing major lower limb amputation identified poor glycaemic control in 90% of patients, with high rates of hypoglycaemia and insulin management errors in 75%. Less than 15% of patients received specialist diabetes input and 20% required third-party assistance for hypoglycaemia.

This quality improvement project aimed to reduce hypoglycaemia, insulin management errors and patient harm events by 50% in vascular surgery patients over a 3-year period. Key interventions over three successive Plan, Do, Study, Act cycles included educational and guideline initiatives (2015), establishing a diabetes in-reach service (2016) and implementing a whiteboard sugar cube alert system for poor glycaemic control (2017). The final introduction of the whiteboard sugar cube alert system delivered the greatest impact in reducing hypoglycaemia rates by more than 50%, insulin management errors by 70% and patient harm events by 75%.

WHERE THIS HAPPENED: Royal Brompton and Harefield NHS Foundation Trust, London School of Hygiene and Tropical Medicine

ProblemFew medical settings have seen such rapid growth in activity over the last two decades as the cardiac catheterisation laboratory (CCL). Currently in the UK, well over 100000 percutaneous coronary intervention (PCI) procedures are performed annually, in contrast to only 10000 at the turn of the millennium.1 Moreover, the nature of the procedures being undertaken has evolved substantially, with newer technologies such as cardiac resynchronisation therapy (CRT) devices2 and transcatheter aortic valve implantation (TAVI)3 becoming established. As a result, the volume—and complexity—of procedures being performed in CCLs has risen dramatically.

WHERE THIS HAPPENED: Royal Cornwall Hospitals NHS TrustAlmost 600 employees at the trust’s hospital and community maternity services have started to use the E3 clinical system from Wellbeing Software.The system, which was rolled out late 2017, allows for an up-to-date and accurate version of a women’s full health record, including scan reports, to be available digitally in one place.This replaces old paper records, which women had to bring to each appointment.Staff have said the new system has helped the trust to “enhance safety”.